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Value for the Future and Breast Cancer–Preventive Health Behavior

¹ Center for Community Based Research, Dana-Farber Cancer Institute; ² Department of Society, Human Development and Health, Harvard School of Public Health, Boston Massachusetts; ³ Department of Medicine, ⁴ Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; ⁵ Leonard Davis Institute of Health Economics, University of Pennsylvania; and ⁶ Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Requests for reprints: Andrea Gurmankin Levy, Dana-Farber Cancer Institute, 44 Binney Street, 253 Smith Building, Boston, MA 02446. Phone: 617-582-7942; Fax: 617-632-5690. E-mail: andrea_gurmankin{at}dfci.harvard.edu

Background: Time preference, or the extent to which people discount future benefits in favor of immediate benefits, might represent an important determinant of preventive health behavior, but the little research thus far on this association has yielded mixed results. This study examined the association between future time preference and use of genetic counseling for BRCA1/2 testing and how this association may differ from the relationship between future time preference and mammography screening and self-breast examination.

Experimental Design: A health system–based case-control study with a nested cross-sectional survey. Eight hundred women who saw a primary care physician in the University of Pennsylvania Health System in the 3 years before the study, of whom 234 had undergone BRCA1/2 counseling (cases) and of whom 566 had not (controls).

Results: Placing a relatively greater value on future benefits than present benefits was strongly associated with use of BRCA1/2 counseling [odds ratio (OR), 3.0 for one-point increase in future time preference; 95% confidence intervals (CI), 1.9-4.9]. Future time preference was weakly associated with adherence to annual mammography (OR, 1.3; 95% CI, 0.81-2.2), and was not associated with monthly self-breast examination (OR, 1.03; 95% CI, 0.75-1.4). A stronger future orientation was seen in women who had higher levels of education (P = 0.0021) or income (P = 0.0011).

Conclusion: Time preference is strongly associated with use of BRCA1/2 counseling. Time preference is more weakly associated with mammography adherence and is not associated with breast self-examination. This variation may reflect the degree to which the behavior is seen as related to future risk. (Cancer Epidemiol Biomarkers Prev 2006;15(5):955–60)

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